Peru, IN / Action Center / Employment Application /

Contact Information

First Name

Last Name

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

Phone Number

Phone Number Area Code-Phone Number Prefix-Phone Number Line Number ext Phone Number Extension

Email

Are you a US Citizen

Yes

No

If no, please explain.

Date of Birth

MonthDay Year,

High school Diploma

Yes

No

GED

Yes

No

Have you ever been employed by a police department? If so where?

Please Do Not Complete The Following Field

Are you ILEA Certified? If so when?

Military Service

Have you ever served in the military on active duty?

Yes

No

Service Record 1

Military Branch

From

MonthDay Year,

To

MonthDay Year,

Highest Rank Attained and Rank at Separation

Type of Discharge and Reenlistment Code

Service Record 2

Military Branch

From

MonthDay Year,

To

MonthDay Year,

Highest Rank Attained and Rank at Separation

Type of Discharge and Reenlistment Code

Criminal History

Have you ever been arrested for a criminal offense?

Yes

No

Arrest Record 1

Date

MonthDay Year,

Location

Charge

Fine or Sentence

Arrest Record 2

Date

MonthDay Year,

Location

Charge

Fine or Sentence

Arrest Record 3

Date

MonthDay Year,

Location

Charge

Fine or Sentence

Certification

I swear or affirm under the penalty of perjury that all information contained in this application is true and accurate to the best of my knowledge.

Signature (Type Name)

I consent to sign and submit this document electronically

Yes

Further information may be required in the future including, but not limited to, high school or college transcripts, resumes, and DD 214s.

The City of Peru, Indiana

Circus Capital of the World

Employment Application

Contact Information

Military Service

Criminal History

Certification

Dialog Title